TETANUS. 59 



(if present) will now be inoculated deep down in the 

 medium, far away from the air. To reduce the supply 

 of oxygen still further it is a good plan to melt some 

 paraffin (a hard candle answers perfectly) and pour a 

 layer an inch thick over the surface of the medium. 



The cultures thus made are to be incubated for a few 

 days at the body-temperature. After about forty-eight 

 hours the growth begins to appear in the deeper portions 

 of the tube as a series of delicate wavy outgrowths from 

 the central stab. These do not appear in the upper 

 portion of the medium, where the oxygen hinders their 

 growth. If the tube shows such a growth it should be 

 submitted to a microscopic examination. It is a good 

 plan to break the tube and to split up the cylinder of 

 medium with a knife ; films are made from the growth 

 and stained as above. Spores are formed after about 

 thirty-six hours. 



The other methods of cultural examination are far 

 more difficult. 



INTERPRETATION OF RESULTS. 



If bacilli having the above characters are found in 

 films, the diagnosis of tetanus must not be considered 

 as being absolutely proven, for there are other bacilli 

 which might be mistaken for those under discussion ; 

 but the probability that the patient will develop the 

 disease is so strong that steps should be taken acccord- 

 ingly. The wound should be scraped and thoroughly 

 treated with antiseptics, and antitoxin should be given. 

 If the deeper portion of the glucose agar stab shows 

 the tree-like growth which has been described and con- 

 tains slender drum-stick bacilli, the case is strength- 



